【摘要】：目的探討肝細胞癌肝切除術(shù)后門靜脈血栓形成的可能原因及預(yù)防措施。方法回顧性分析2010年1月至2013年12月第二軍醫(yī)大學(xué)附屬東方肝膽外科醫(yī)院收治的10例肝細胞癌肝切除術(shù)后門靜脈血栓形成的病人資料,包括一般資料、既往病史、術(shù)前檢查、術(shù)中情況、術(shù)后檢查診斷及治療措施等。結(jié)果門靜脈血栓確診時間為術(shù)后3~15 d,平均為6.6 d。術(shù)后9例病人出現(xiàn)肝功能迅速惡化,表現(xiàn)為術(shù)后丙氨酸氨基轉(zhuǎn)移酶(ALT)、總膽紅素(TBIL)逐漸下降后突然升高,確診當(dāng)日TBIL為159.4(9.5~472.9)μmol/L,ALT為1175.4(73.9~5485)U/L。6例病人術(shù)后行D-二聚體檢查,其中5例(83.3%)明顯升高(20 mg/L),1例輕度升高(≤20 mg/L)。10例均常規(guī)術(shù)后使用止血藥物,且均于確診門靜脈血栓后開始使用低分子肝素抗凝治療。3例抗凝治療后門靜脈血流恢復(fù),好轉(zhuǎn)出院;6例因急性肝功能衰竭死亡;1例因急性腎功能衰竭、感染性休克死亡。結(jié)論肝細胞癌肝切除術(shù)后門靜脈血栓形成可以導(dǎo)致病人術(shù)后肝功能衰竭甚至死亡,故建議肝切除術(shù)后宜慎用止血藥并早期抗凝。
[Abstract]:Objective to investigate the possible causes and preventive measures of venous thrombosis after hepatectomy for hepatocellular carcinoma (HCC). Methods from January 2010 to December 2013, the data of 10 patients with venous thrombosis after hepatectomy were retrospectively analyzed, including general information, past medical history, and preoperative examination, in the oriental hepatobiliary surgery hospital affiliated to the second military Medical University. Intraoperative condition, postoperative examination, diagnosis and treatment, etc. Results the diagnosis time of portal vein thrombosis was 3 ~ 15 days (mean 6.6 days). Liver function deteriorated rapidly in 9 patients after operation, which showed that the total bilirubin (TBIL) of alanine aminotransferase (ALT), decreased gradually and then increased suddenly. The TBIL on the day of diagnosis was 159.4 (9.5 鹵472.9) 渭 mol / L alt 1175.4 (73.9 鹵5485) U/L.6 patients underwent D-dimer examination. Among them, 5 cases (83.3%) were significantly elevated (20 mg/L), 1 case was slightly elevated (鈮，

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